Mold and Lyme garner greater attention from both chronically ill patients and functional medicine practitioners, but they are not alone in the biotoxin world. Spider bites and bartonella, the bacteria behind cat scratch disease, are also generally recognized as triggers for the Chronic Inflammatory Response Syndrome (CIRS). Lesser attention, however, is paid to toxic algae like cyanobacteria which may trigger CIRS just as severe and chronic as the more well-known biotoxin villains.
Cyanobacteria, often called blue-green algae, use sunlight to make energy, similar to plants, and can live in fresh, salt, and brackish water. Algae in general help our ecosystem by supplying a large portion of our oxygen. Meanwhile, like other organisms which make biotoxins, they make these chemicals which negatively impact other organisms in the fight for survival. Like other biotoxin producers, the amount of toxins varies based on their surrounding environment and their growth rate.
When algae experiences a bloom, or great increase in their growth, they may produce larger than normal amounts of their toxins. In small or large amounts, the algae toxin works its way into other organisms either by fish eating the algae and concentrating the toxin or through our water supply becoming contaminated. Like all toxins generally, a small amount may not cause symptoms, but after a threshold is crossed, more and more symptoms do arise in the ingesting and exposed organisms.
While the toxicity of cyanobacteria or blue-green algae has been recognized both in local stories and by some scientists, a fuller understanding continues to develop. Technology which allows measurements of these toxins in small concentrations is opening doors to better studies. A changing environment due to industry and the spread of humans across more of the earth is also helping bring attention to this knowledge deficit. This article will provide an overview while the resources offer much longer and more detailed explanations.
Like other biotoxins, the collection of biotoxins made by cyanobacteria impact multiple functions and systems of the human body. Two of the major groups of cyanobacteria toxins include the microcystin and the nodularin families. As always, different specific toxins will have varying effects, but for now, there are a few generalities which arise with these toxins. The understanding of these toxins comes from documenting actual human and animal exposures to algae blooms, as well as from some studies on lab animals exposed to controlled amounts of the toxins.
For humans, the exposure may come through ingestion, skin exposure, or inhalation. With skin exposure, the expected rashes, blisters, and allergic reaction can occur. The eyes may also be affected when swimming through such algae blooms. Sometimes, the exposures can be great enough that systemic symptoms like asthma, cough, and vomiting have been documented.
In cases of inhalation, nasal mucosa and lung mucosa may be damaged. This can occur during watersports or industrial spraying of contaminated water.
Hemodialysis of kidney failure patients has served as unusual examples of what contaminated water can do. Unrecognized algae blooms in the water supply have led to a number of seriously affected patients at these kidney clinics when water was not adequately treated. Symptoms included further kidney damage, liver damage, GI bleeding, cardiovascular problems, and more.
When the toxins are ingested in water, other symptoms may develop. Vomiting, abdominal pain, liver enlargement, headaches, lethargy, diarrhea, and organ damage has been documented. The liver, being an organ of detoxification, has been found affected through elevated liver enzymes in blood testing after exposure. Some links with liver cancer and death are suspected.
The ingestion of these toxins in food is less well understood. No definite cases currently exist on eating contaminated fish. Suspicions that long-term low-level exposures from fish ingestions exist, but studies are ongoing. Other types of biotoxins like dinoflagellates in marine shellfish are known to cause similar intoxications, so it is likely that cyanobacteria do so as well.
As with other biotoxins, many different effects occur in the immune system (Lone). Increases and decreases in various cells, cytokines, and growth factors dysregulate the immune system. Further study is needed.
As we care for patients in our office, we ask a long exposure history. When dealing with CIRS patients, we ask a lot of questions to determine if someone has spent a lot of time in potential algae water sources. For cyanobacteria, these focus on lakes and rivers or living near freshwater estuaries. While most of our patients appear to have CIRS illnesses from mold, Lyme, or bartonella, we do have a few patients who likely developed their illness from algae toxin exposures. Thankfully, similar detox protocols work for all of these biotoxins, but determining the toxin and its source allows us to guide the patient away from future exposures.
Resources:
CODD, GEOFFREY A., et al. “Cyanobacterial Toxins, Exposure Routes and Human Health.” European Journal of Phycology, vol. 34, no. 4, 1999, pp. 405–415., doi:10.1080/09670269910001736462.
R.M Dawson, the toxicology of microcystins, Toxicon, Volume 36, Issue 7, 1998, Pages 953-962, ISSN 0041-0101, https://doi.org/10.1016/S0041-0101(97)00102-5.
Nicole L. McLellan, Richard A. Manderville, Toxic mechanisms of microcystins in mammals, Toxicology Research, Volume 6, Issue 4, July 2017, Pages 391–405, https://doi.org/10.1039/c7tx00043j
Yaqoob Lone, Mangla Bhide, Raj Kumar Koiri, “Microcystin-LR Induced Immunotoxicity in Mammals”, Journal of Toxicology, vol. 2016, Article ID 8048125, 5 pages, 2016. https://doi.org/10.1155/2016/8048125
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.
